Treatment for Conjunctivitis (Pink Eye)
The treatment for conjunctivitis depends on its cause, with viral conjunctivitis requiring supportive care, bacterial conjunctivitis potentially benefiting from topical antibiotics, and allergic conjunctivitis responding to antihistamines and mast cell stabilizers.
Viral Conjunctivitis
Viral conjunctivitis is the most common form and typically self-limiting:
- Supportive care is the mainstay of treatment, including artificial tears, cold compresses, and topical antihistamines to alleviate symptoms 1, 2
- Patients should be educated about hygiene measures to prevent spread, including frequent handwashing and avoiding contact with others for 10-14 days 1
- Antibiotics should be avoided as they provide no benefit and may cause adverse effects 1
- For severe cases with marked chemosis, lid swelling, or membranous conjunctivitis, a short course of topical corticosteroids may be beneficial but requires close monitoring 1
Bacterial Conjunctivitis
Bacterial conjunctivitis is generally self-limiting but may benefit from treatment:
- Topical antibiotics such as bacitracin or erythromycin ointment can be applied directly to the conjunctival sac 1-3 times daily 3, 4
- Treatment with antibiotics shortens the duration of symptoms and allows earlier return to work or school 2, 5
- In one study, 62% of patients receiving topical antibiotics were clinically cured by days 3-5 compared to only 28% of those receiving placebo 5
- For conjunctivitis caused by gonorrhea or chlamydia, systemic antibiotics are required in addition to topical therapy 2
Allergic Conjunctivitis
Allergic conjunctivitis treatment focuses on symptom relief and allergen avoidance:
- Initial measures include avoiding allergens, wearing sunglasses as barriers, applying cold compresses, and using refrigerated artificial tears 1
- Mild cases can be treated with over-the-counter topical antihistamine/vasoconstrictor agents 1
- More effective second-generation topical histamine H1-receptor antagonists are recommended for better symptom control 1
- For chronic or recurrent cases, mast cell stabilizers or combination antihistamine/mast cell stabilizer medications are effective 1
- If symptoms are inadequately controlled, a brief course (1-2 weeks) of topical corticosteroids with a low side effect profile can be added 1
- Concomitant use of cooled preservative-free artificial tears can alleviate tear deficiency and dilute allergens 1
- For severe cases, topical cyclosporine or tacrolimus may be considered 1
Special Considerations
Vernal/Atopic Conjunctivitis
For more severe allergic forms:
- Environmental modification and cool compresses with ocular lubricants are first-line measures 1
- Topical and oral antihistamines and mast cell stabilizers help maintain comfort 1
- Acute exacerbations often require topical corticosteroids 1
- Cyclosporine 0.1% is FDA-approved for vernal keratoconjunctivitis in children and adults 1
- For severe cases unresponsive to topical therapy, supratarsal injection of corticosteroid may be considered 1
Monitoring and Follow-up
- Follow-up frequency depends on severity, etiology, and treatment 1
- If corticosteroids are used, baseline and periodic IOP measurement and pupillary dilation should be performed to monitor for glaucoma and cataract 1
- Patients with allergic conjunctivitis should be monitored for keratoconus, as adequate control of allergy and prevention of eye rubbing are important to decrease progression of corneal ectasia 1
Common Pitfalls to Avoid
- Avoid indiscriminate use of antibiotics for viral conjunctivitis 1, 2
- Avoid prolonged use of vasoconstrictors as they can cause rebound vasodilation 1
- Oral antihistamines may worsen dry eye syndrome and impair the tear film's protective barrier 1
- Punctal plugs should be avoided in allergic conjunctivitis as they prevent flushing of allergens and inflammatory mediators 1
- When using corticosteroids, be aware of potential complications including increased IOP and cataract formation 1